Thinking Developmentally About Signs of ASD

Autism is a developmental disorder, meaning that the child’s pattern of growth across areas of development is uneven, with different skills growing at different rates than each other.  For example, you may observe a 2-year-old decoding words in books, but not speaking spontaneously. 

Some skills even seem to develop in a different sequence than in typically developing children. For example, imitation skills develop on a different timeline and in a different set of steps in children with autism than in typically developing children or those with global developmental delays (Rogers, 2010). 

The duration of developmental periods may also be different in ASD - for example, while typically-developing children go through a phase of echoing what other people say during the toddler years (called “echolalia”), a child with ASD may continue to echo others across childhood and into adulthood.  A child with a history of evenly developed skills, that appear to follow the expected developmental sequence, but with slower rates of skill acquisition, is usually described as a child with a developmental delay; not a disorder.  For example, if a child is chronological 7 years old, and has an overall developmental level of a 3 year old (in other words, solves problems more like a 3-year old), and his social and communicative skills are also at about a 3-year old level, then the child is presenting with a developmental delay, but not a developmental disorder. If, however, this 7-year-old child solved problems without language (such as puzzles) at a 7-9 year old developmental level, but interacted socially with others at about a 2-year old level, then this child can be thought of as presenting with a developmental disorder, and not a developmental delay. 

It’s very important when screening for ASD to be familiar with how “typical” development usually emerges.  Although every child develops and grows in a unique way, there are expected developmental sequences of particular skills and behaviors across childhood. (See the table below for a summary of behavioral signs and their associated ages when one is likely to observe them).

Table 1: Thinking developmentally about the signs of ASD

AGE OF CHILD

POSSIBLE SIGNS OF ASD

Birth to 12 months (infancy)

·         No babbling or fewer vocalizations with a limited range of sounds

·         No pointing or gesturing

·         “Out of sync” with caregiver

·         Doesn’t smile at people

·         Delayed response to name

·         Poor social orienting

12 to 36 months

(toddlerhood)

·         No single words by 16 months

·         No spontaneous 2-word phrases by 24 months

·         Any signs of loss of language or social skills

·         Lack of response to name

·         Poor coordination of eye gaze with other communicative behaviors (such as gestures)

·         Lack of spontaneous imitation

·         Failure to follow another person’s point towards an object or event of interest

·         Lack of shared enjoyment

·         Doesn’t respond to name when called

·         Limited repertoire of play activities

3 years

·         Doesn’t understand simple instructions

·         Doesn’t  speak in sentences

·         Doesn’t make eye contact

·         Doesn’t play pretend or make-believe games that are original/invented

·         Doesn’t show interest in playing with other children of the same age

·         Shows interest in parts of objects instead of the whole object

·         Doesn’t understand simple instructions

·         Doesn’t  speak in sentences

·         Doesn’t make eye contact

·         Doesn’t play pretend or make-believe games that are original/invented

·         Doesn’t show interest in playing with other children of the same age

·         Shows interest in parts of objects instead of the whole object

·         Seems to prefer objects over people

4 years

·         Has difficulty with fine motor skills (such as scribbling with a crayon)

·         Shows little interested in interactive games or make-believe

·         Ignores other children or responds in a limited way to people outside the family

·         Resists dressing, sleeping and/or using the toilet

·         Doesn’t seem to understand “same” and “different”

·         Doesn’t use  “me” and “you” correctly or calls self by own first name

·         Doesn’t follow 3-part commands consistently

·         If speaking in sentences:  has trouble retelling a favorite story in a way that is clearly understood by others

5 - 11  years

(elementary school)

 

·         Doesn’t show a range of emotions or emotions don’t always seem to fit the situation

·         Shows extreme behaviors at times  (unusually aggressive, shy or sad)

·         Is often unusually withdrawn and not active or “in his own world” and active in a somewhat “agitated” or “self-propelled” manner

·         Is easily distracted, has trouble focusing on one activity for more than 5 minutes

·         Doesn’t respond consistently to people, or responds only superficially or inconsistently

·         Tends to take things literally and has trouble telling the difference between what’s real and what’s imaginary

·         Doesn’t play a variety of games and activities

·         Has trouble providing first and last name when asked

·         Doesn’t use plurals or past tense properly

·         May drop articles or words like “the” or “an” when speaking

·         Doesn’t often try to tell others about own experiences

·         Doesn’t draw pictures from her imagination

·         Has trouble with brushing teeth, washing hands and other hygiene routines, even though it seems like he should be able to do it

5 - 11  years

(elementary school)

·         Difficulty making friends with same-aged peers

·         Limited social reciprocity (i.e., spontaneous, fluid, back-and-forth social interaction, with changes in social behaviors as a result of changes in one’s social partners‘ behavior or changes in the social context – for example: smiling at others who smile at you, asking someone else a question after talking about own interests.

·         Limited understanding of social rules/conventions (i.e. may not use eye gaze during conversation or may not shift gaze away from partner, does not use gestures (hand movements) to emphasize meaning or emotions in conversation)

·         Limited understanding of other peoples’ feelings and perspectives

·         Nonverbal behaviors tend to be less well-coordinated; less “natural” and fluid

·         If verbal, language tends to be unusual (i.e., formal, repetitive, pedantic (like giving a lecture), may use made-up words, may repeat scripts - or memorized bits of dialogue heard in movies or books - to self or with others

·         Limited play skills

·         Tendency to focus on a particular interest or topic and always return to that interest/topic

·         Strong preference for routine and predictability

·         Anxious, which may present as irritable or overly negative and/or controlling, particularly around anything new or that is a change from previous expectations and experience

·         Preoccupation with rules, fairness & justice with a very literal interpretation of events and little tolerance for ambiguity

12 - 18 years

(middle & high school)

·         Lack of insight (particularly with regard to social relationships, social conventions, and sense of personal responsibility)

·         Discrepancy between intellectual potential and competence in self-care and personal safety

·         Difficulty understanding the nonverbal cues of others in a rapid, automatic, in-the-moment fashion

·         Unusual prosody (i.e., way of talking; refers to the rate, rhythm and volume of speech, modulation of voice to express emotion)

·         Difficulty with organization, goal setting, planning, initiation, decision making, etc. which adversely impacts school work (sometimes called problems with executive functioning)

·         Misinterpretation of the intentions of others (may be socially naïve or overly blaming)

·         Restricted range of interests and activities, characterized by impatience or disinterest when others are expressing their interests

Think about the difference between a developmental delay and a developmental disorder.  Remember, autism is a developmental disorder, meaning that the child’s pattern of growth across areas of development is uneven, with different skills growing at different rates than each other.  For example, you may observe a 2-year-old decoding words in books, but not speaking spontaneously. 

Some skills even seem to develop in a different sequence than in typically developing children. For example, imitation skills develop on a different timeline and in a different set of steps in children with autism than in typically developing children or those with global developmental delays (Rogers, 2010).  Young children imitate with objects first, whereas children with other developmental delays (and those developing typically) imitate gestures and body movements first.  Another example is the relatively frequent report of young children with autism skipping some of the “pre-walking” stages (such as walking while holding onto something) when taking their initial steps.

The duration of developmental phases may also be different in ASD - for example, while typically-developing children go through a phase of echoing what other people say during the toddler years (called “echolalia”), a child with ASD may continue to echo others across childhood and into adulthood.  

Keep in mind:  A child with a history of evenly developed skills, that appear to follow the expected developmental sequence, but with slower rates of skill acquisition, is usually described as a child with a developmental delay, not a disorder.  For example, if a child is chronological 7 years old, and has an overall developmental level of a 3 year old (in other words, solves problems more like a 3-year old), and his social and communicative skills are also at about a 3-year old level, then the child is presenting with a developmental delay, but not a developmental disorder.

In contrast:  A child with a history of unevenly developed skills, that appear to follow an unexpected developmental sequence, with different rates of skill acquisition across different skills is usually described as a child with a developmental disorder, not a global delay.  For example, consider a 7-year-old child who solves problems without language (such as puzzles) at a level very comparable to his same-aged peers (i.e., 7-9 years), but interacts socially with others at about a 2-year old level, then this child can be thought of as presenting with a developmental disorder, and not a developmental delay.